The cost-effectiveness of implementing HPV testing for cervical cancer screening in El Salvador
The cost-effectiveness of implementing HPV testing for cervical cancer screening in El Salvador
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DOI：
10.1002/ijgo.12773
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发表时间：
2019-04-01
影响因子：
3.8
通讯作者：
Kim, Jane J.
中科院分区：
文献类型：
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作者：
Campos, Nicole G.;Maza, Mauricio;Kim, Jane J.
目的评估在萨尔瓦多宫颈癌预防示范（CAPE）第2阶段中，HPV阳性妇女的HPV筛查和管理算法的成本效益，并与目前的Pap-based筛查进行比较。方法使用CAPE示范第2阶段（n=8000名妇女）的数据来建立HPV感染和宫颈癌的数学模型。该模型用于预测HPV检测每5年（30-65岁）的终身健康和经济结果，HPV阳性女性转诊阴道镜检查; HPV检测每5年（30-65岁），符合条件的HPV阳性女性立即冷冻治疗;以及Pap检测每2年（20-65岁），Pap阳性女性转诊阴道镜检查。尽管与第一阶段相比，接受治疗的HPV阳性妇女比例略有下降，但第二阶段筛查对健康的影响保持稳定，癌症风险降低了58.5%。与第一阶段一样，对符合条件的HPV阳性妇女进行HPV检测和冷冻治疗仍然是成本最低和最有效的策略（每年挽救生命490美元）。结论在萨尔瓦多，对所有符合条件的妇女进行HPV筛查后立即冷冻治疗是非常划算的。
Objective To assess the cost-effectiveness of HPV-based screening and management algorithms for HPV-positive women in phase 2 of the Cervical Cancer Prevention in El Salvador (CAPE) demonstration, relative to the status quo of Pap-based screening. Methods Data from phase 2 of the CAPE demonstration (n=8000 women) were used to inform a mathematical model of HPV infection and cervical cancer. The model was used to project the lifetime health and economic outcomes of HPV testing every 5 years (age 30-65 years), with referral to colposcopy for HPV-positive women; HPV testing every 5 years (age 30-65 years), with immediate cryotherapy for eligible HPV-positive women; and Pap testing every 2 years (age 20-65 years), with referral to colposcopy for Pap-positive women. Results Despite slight decreases in the proportion of HPV-positive women who received treatment relative to phase 1, the health impact of screening in phase 2 remained stable, reducing cancer risk by 58.5%. As in phase 1, HPV testing followed by cryotherapy for eligible HPV-positive women remained the least costly and most effective strategy (US$490 per year of life saved). Conclusion HPV-based screening followed by immediate cryotherapy in all eligible women would be very cost-effective in El Salvador.